North Penn Hernia Institute
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INGUINAL HERNIAS, or 'groin' hernias, {Photo}, are by far the most common site for hernia development in adults, and are second in frequency only to Umbilical Hernias in infants and children. While a bit more common in men, they also do occur in women with a ratio of about 10 to 1. See additional information published by the American College of Surgeons on Inguinal Hernias

Inguinal Hernias develop as the result of a weakness, tear, gap or opening in the abdominal wall of the lower abdomen or groin, at a region called the inguinal canal. As a result of this opening, the contents of the abdomen such as intestine, may protrude through the abdominal wall muscle, creating localized pain and/or a bulge. The pain and bulge may be constant or intermittent in duration and mild or severe in intensity. Inguinal Hernias are located in the lower abdomen (right side, left side or both) just above the leg crease, near or adjacent to the pubic area {Photo}. Inguinal Hernias occur on both sides ('Bilateral') in about 8-10% of patients.

Inguinal Hernias may be Congenital (present since birth), yet they may not become evident with pain or as a bulge until later in life. Inguinal hernias can also be Acquired, the result of repetitive pressure, strain or injury, further weakening the structural integrity and function of the abdominal wall in the inguinal area. This process may be acute and occur abruptly, or it may develop slowly and virtually asymptomatically over a long period of time. Purely congenital hernias are often called "Indirect" hernias, whereas acquired hernias are referred to as "Direct" hernias. They are so called because of their anatomic direction of travel into the hernia-vulnerable area known as the Inguinal Canal.

These hernias frequently show up as a "bulge" in the groin region which gradually increases in size and becomes progressively more uncomfortable. Sometimes, only a mild pain, ache or burning occurs in the area before the development of an obvious bulge. At this stage, while a bulge may not be visibly evident to the patient, detailed examination by a skilled and knowledgeable physician can detect and diagnose these hernias. The initial discomfort heralding the onset of symptoms of a hernia is often described as an ache or burning sensation. Discomfort may not only be present in the inguinal area, but may also radiate into the hip region, back, leg or even down towards the genitalia region. Called "REFERRED PAIN", this more diffuse discomfort can be quite bothersome and at times severe. In general, discomfort with hernias usually increases with duration of activity (e.g.,standing or vigorous exercise). It then becomes relieved, although not always completely, with rest.


Inguinal Hernias in adults, either primary or recurrent, cannot be cured medically nor can they be healed by diet, vitamins or exercise. Rather, they require surgical correction for effective therapy. Inguinal Hernias are virtually all ideally suited for surgical repair using an advanced TENSION FREE, mini-incision, open technique. This benchmark approach, which we have promoted and utilized for over 20 years, is in our opinion not only the safest, but also the most effective contemporary method for hernia repair available today. Rather than pulling muscle edges tightly together and suturing under extreme tension as was the prior traditional repair technique, the Tension-Free approach allows us to customize and tailor a specifically selected mesh product to the exact size and configuration required for each patient and each individual hernia. Hernias differ from patient to patient and so a "one size fits all" approach is obviously much less effective.

The important fundamental principle of this contemporary, tailored TENSION FREE TECHNIQUE is to avoid tension on tissues and to neither cut nor sew muscle together in an unnatural high-tension fashion. We safely and effectively utilize sterile, flexible yet sturdy light-weight mesh to support the tissue for a complete hernia repair. It is quite effective for both primary and recurrent inguinal hernias as well as virtually all abdominal wall hernias. Mesh (sterile, wafer-thin, flexible and pliable) is carefully placed under (and at times above as well) the hernia defect, extending safely beyond the under edges of the defect to "immediately" repair the hernia. The mesh covers not only the hernia defect itself, but importantly reinforces an area of ever-present thinned and weaken tissue that surrounds all hernia defects. Unlike as is the case in many other hernia repair techniques, this important surrounding weakened area of hernia vulnerability, which in the inguinal area is called the Myopectineal Orifice, is fully addressed in our Tension-Free approach. Thus, the risk of a recurrent hernia is virtually eliminated. Moreover, the sterile mesh acts as a "lattice", "growth bed" or "scaffolding" for new tissue in-growth. Such in-growth will not only continue to 'heal' the defect further with time, but will go on to allow full incorporation of the mesh, safely and comfortably, into the abdominal wall itself. Since the mesh is thin, pliable and flexible, the patient is totally unaware of its presence. Activity is not limited after this Tension-Free hernia repair method. The hernia repair is immediately strong, effectively and completely repaired by the mesh, so restrictions postoperatively are minimal. Importantly as well, patients return rapidly to Normal Activity!!

for NPHI Patients

This surgical method is superior to other hernia repair techniques including:

Our extensive experience allows us to specifically repair these hernias by selecting the appropriate Mesh product that is best suited for the findings at the time of surgery. Unlike most surgeons, we do not perform only "ONE" type of procedure or utilize one type or make of mesh. We feel that hernias differ, sometimes significantly from patient to patient. Therefore, the surgical procedure, technique and products used must be TAILORED specifically to the patient and the anatomy of the individual hernia. This philosophy forms the foundation of our Tension Free' approach. All of these techniques however, utilize the fundamental principle of a TENSION FREE mesh repair and are safe, strong, resilient and fully effective. Rather than performing only one single method, we utilize our experience to select the most appropriate Mesh product from a wide range of sizes, shapes and designs. This allows us to tailor both the procedure, and the product to the specific requirements of the patient, rather than utilizing a 'one-size-fits-all' philosophy.

Mesh is safely placed under the abdominal wall defect where it is most effective, and cannot later be lifted off or separated by abdominal pressure or strenuous physical activity. We offer these exciting techniques to our patients to assure them the best possible repair of their hernia, with the lowest overall risk of post operative problems or recurrent hernia formation. Since the procedure is "Tension Free", meaning muscle is neither cut nor sewn tightly together in the process, there is minimal post operative pain, allowing patients to actually resume virtually NORMAL activity as they like with few if any restrictions.

The surgeons and staff at The North Penn Hernia Institute are fully trained in the contemporary, state-of-the-art management and surgical repair of all abdominal hernias, including new and recurrent Inguinal Hernias. Surgical repair is most often performed under mild sedation and local anesthesia, with Minimal Surgical Invasion. Our advanced "Tension Free" Technique is performed as an outpatient, allowing discharge on the "Same Day".

Return to
Normal Work and Activity in Days.

Surgery performed at